Digital tools such as apps on smartphones/tablets for care documentation or to remind patients to take their medication, as well as wearables for collecting and analysing health data, are just a few examples that show that digitalisation in healthcare is advancing inexorably (eHealth Suisse, 2018; Zentrum für Qualität in der Pflege [ZQP], 2019).

Everyone is currently talking about the challenges associated with a demographically induced high demand for healthcare services, the increasingly acute shortage of skilled workers and a rising prevalence of chronic diseases (Gigerenzer et al., 2016; ZQP, 2019). For these challenges, digital transformation is considered an indispensable measure for overcoming them, so that a high and financially sustainable quality of care can still be made possible (Federal Office of Public Health [FOPH], 2019; World Health Organization [WHO], 2019). All care settings are affected, i.e. hospitals, long-term institutions, outpatient clinics and Spitex. The digital transformation is changing the way of working and thinking and consequently the competence profile of health professionals.

In concrete terms, the traditional job description is being expanded by technical components. What does this mean for nursing professionals in the Spitex setting? It has already been shown that technologies can promote an intersectoral networking of health care professionals and that caregivers also benefit from the digital availability of client files. Keywords here include availability, traceability or data-based process control. In order to enable a safe and effective use of different technologies, hospital nurses need digital competence (Müller, 2020). In a qualitative study, we investigated what nurses in Spitex understand and expect by digital competence in direct client contact and in a leadership function. Between October and December 2020, 22 nurses from nine Spitex institutions in Switzerland took part in an interview or a focus group discussion.

Digital and analogue skills are in demand

The results show that Spitex nurses locate digital competence in a field of tension between individual skills and the prerequisites created by the system. In addition to the many digital aspects, analogue skills such as relationship building, communication and specialist knowledge are also inextricably linked to digital skills. This means that in dealing with technology, digital and analogue competence cannot be clearly demarcated and are thus understood as an interplay.

This interplay is not easy with the integration of technology in relationship building, communication and in the care process and must be learned and trained. It is also influenced by the fact that clients are digitised in different ways and, depending on the area of application, they tend to approve of the technology or perceive it as a hindrance to personal interaction with the carer. Therefore, carers are challenged to find adequate individual responses and to implement measures. However, the results also show that dealing with digitalisation can trigger fear. This fear is caused by the fear of doing something wrong without being able to undo it. In addition, fear arises from feeling insecure in dealing with technologies or newly digitalised processes. Here, the study participants call for a timely, individual and step-by-step introduction to new digital applications. Furthermore, the participants recommend that training goes beyond handling a specific technology in order to convey a comprehensive understanding of new ways of thinking and proceeding, because:

“If I don’t quite get to grips with electronics myself, I am so busy myself that I can’t perceive the other person enough. I can then perceive the social competence less. And I would find that a pity if it came to that.” (Focus group 1, qualified nurse)

This quote aptly shows that nurses also expect human solutions from the digital transformation, whereby social interaction is given a special position in the context of the digital competence profile: Digital care needs analogue interactions. Carers demand “tailor-made” technologies for practice, which are to be understood as a supplement to everyday life and not as a substitute for personal interaction between carer and cared-for person, the heart of care.

Role models and support are needed

The participants also demand a competent contact point for the development and deepening of their digital competence; because savoir-faire and role model function, characterised by a noticeable will for change on the part of management persons, convey security. The concrete benefits of technologies for everyday care should be demonstrated. Although management personnel are not expected to know the level of digital competence of individual staff members at all times, they should actively inform themselves about it when necessary in order to be able to support individual caregivers individually.

On the other hand, the participating management staff appealed for a pronounced personal responsibility and independence of the nurses with regard to the development and use of their digital competence. This is important to them, as they are left to their own devices in the daily routine of Spitex and do not have a constant opportunity for exchange, as is the case with “on-site teams”, e.g. in hospitals. They also demand from their staff that they are open and motivated towards (digital) innovations and that they also support each other collegially in the team, as the sole support possibility of an institution cannot be sufficient. Another result shows that both nurses in direct daily contact with clients and nurses with management functions would like to have an active say in shaping the digital transformation, so that the digital offers can be oriented towards the actual needs of nursing despite their rapid further development.

In particular, carers should and would like to be able to tell IT professionals what is needed. Because not everything that is technically possible can also be ethically justified or makes sense from a care perspective. According to the study participants, this is the only way to develop and integrate care technologies that are easy to understand, uncomplicated to use and practicable in everyday life.

Conclusion and outlook

This qualitative study shows that the interviewed nurses do not understand digital competence as an isolated concept that is primarily about technical skills. They understand digital competence to be strongly coupled with analogue competence such as relationship building and communication. The “right” combination of technical skills and analogue competence seems to be the key to success.

However, it is still unclear what is meant by the “right” combination. The current research situation also shows that digital competence in care has not yet been clearly identified, but merely refers to the willingness of outpatient caregivers to use technology (Hülsken-Gieser et al., 2019). It is therefore necessary to concretise digital competence in care in a way that is relevant to practice. In order for nurses to acquire digital competence, i.e. to carry out digital tasks, solve problems, manage information and create content or use it effectively and efficiently, nursing education is of central importance.

Beyond the organisational structure, it would be desirable if the examination of technologies became a fixed curricular component of training – in this way, the technology and digitalisation potential could be fully exploited and nurses could be effectively prepared for the dynamics of digital requirements in the nursing environment. In a future-oriented nursing care, the nurses themselves are required to design their activities for a technologised and digitalised working environment – competences and skills are needed that allow the simultaneous development and application of digital and analogue requirements belonging to a process or an activity.

Literature

1. Boll-Westermann, S., Hein, A., Heuten, W., & Krahn T. (2019). Pflege 2050 – Wie die technologische Zukunft der Pflege aussehen könnte. In Centre for Quality in Care [ZQP] (Ed.), Care and digital technology (pp. 10-15). ZQP. https://www.zqp.de/produkt/report-digitale-technik/
2. Federal Office of Public Health [FOPH]. (2019). The Federal Council’s Health Policy Strategy 2020-2030. Swiss Confederation. https://www. bag.admin.ch/bag/de/home/strategie-und-politik/gesundheit-2030/gesundheitspolitische-strategie-2030.html
3. Eggert, S., Sulmann, D., & Teubner, C. (2019). ZQP analysis – What are the attitudes of the population towards digital and technical applications in care. In Centre for Quality in Care [ZQP] Report (Eds.), Care and digital technology (pp. 16-30). ZQP. https://www.zqp.de/produkt/report-digitale-technik/
4. eHealth Suisse. (2018). Strategy eHealth Switzerland 2.0. 2018-2022. Goals and measures of the Confederation and cantons for the dissemination of the electronic patient dossier and for the coordination of digitisation around the electronic patient dossier. https://www.e-health-suisse.ch/fileadmin/user_upload/Dokumente/2018/D/181214_Strategie-eHealth-Suisse-2.0_d.pdf
5. Gigerenzer, G., Schlegel-Matthies, K., & Wagner, G. G. (2016). Digitale Welt und Gesundheit. eHealth und mHealth – Chancen und Risiken der Digitalisierung im Gesundheitsbereich. In Sachverständigenrat für Verbraucherfragen [SVRV] (ed.), Digitalisierung im Gesundheitsbereich – Wie verändert sich der Gesundheitssektor? (S.12-17). SVRV.
6. Hülsken-Giesler, M., Daxberger, S., Peters, M., & Wirth, L. M. (2019). Technology readiness in ambulatory care. Nursing, 32(6), 334-342. https://doi.org/10.1024/1012-5302/a000702
7. Müller, J. (2020). DIGITISATION. How to get your team on board. kma-Klinik Management aktuell, 25(01/02), 54-55.
8. World Health Organization [WHO]. (2019). Global Strategy on Digital Health 2020-2024. https://cdn.who.int/media/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf?sfvrsn=f112ede5_75